Grief is a normal, necessary psychological process that helps a person adapt to the loss of a loved one. The survivor is depressed and often withdraws from former interests, activities and even friends. Grief is a very personal experience; even among members of a family who lose the same person, the experience of the loss will be different for each person. The closer the relationship to the deceased, the greater the loss.

For an adult, the psychological work of grief is connected with remembering and reliving the experiences shared with the person who has died. Grief is not a consciously determined task; rather, it is set motion automatically and proceeds at the rate that is bearable for the individual. Grieving is painful because, as we remember good times as well as bad, the very process of remembering requires a continuing recognition that the person we loved is no longer present.

The outward signs of grief are similar to those of depression and generally include intense mental anguish, remorse and sorrow. But these are mere words, and cannot describe the emotional pain and shock experienced by a person who mourns. He or she has lost love, goals, friendship or security, none of which are immediately replaceable.

The depth of grief is unpredictable because it depends on so many factors, including the availability of support from family, children, and friends; one's culture or religion, and the degree of preparation for the event. Although there is no universal approach to the grieving process, many people follow specified religious procedures. Each of the major religions observes a degree of ritual, quite similar in format, when dealing with death.

As health care providers we deal with these problems frequently, and try to prepare a patient's family and friends for an anticipated death. We do this by providing medical information and by holding family conferences on the patient's progress. Yet no matter how thoroughly we prepare them, families still experience shock and momentary disbelief when death occurs. In addition, questions will be asked and decisions required of them. Will there be a postmortem? What funeral arrangements must be made. The doctor can be helpful at such a time, because those that were close to the patient are typically not thinking or remembering clearly. If the disease was chronic, funeral arrangements may have already been completed, or at least initiated by the family.

When the funeral is over, the family, as well as members of the medical team who have been involved with the patient, need time for their own sorrow to abate. At this time, we usually write the family a letter expressing both sympathy and hope for the future. A review of the patient's medical problem and the therapy is provided, along with pertinent autopsy information if required. These steps help to clear up any questions or misunderstandings among family members about what actually occured, especially during the final days, when their comprehension may have been clouded by concern for the patient. We have found this approach very helpful for the grieving process.

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During the first few weeks, phone calls, visitors and cards of sympathy distract the attention of the grief-stricken. Often there is denial of mourning, an attempt to hold back tears and suppress grief. Crying is believed by some people to be a sign of weakness, but it is merely a means of releasing pent-up emotions.

When the attention diminishes and one is left alone with the uncertainty of the future, the feelings of fear and loneliness arise and are natural. However sometimes grief occurs simultaneously with unremitting depression, in which the survivor becomes obsessed with loss. When this happens, feelings of persistent loneliness, helplessness, guilt, shame and anger may lead to a repressed state, and professional help may be required. Grief seems to be endless and recovery may seem impossible, but grief must be allowed to run it's course.